Hand Pathologies Flashcards
What is Duputren’s contracture?
- A proliferative connective tissue disorder
- Leads to the formation of nodules and cord
- Progresses to contractures at the MCP and PIP joints
What is the pathology behind Dupuytren’s contracture?
- Proliferation of myofibroblast cells
- Production of abnormal collagen (type 3 vs type 1)
Dupuytren’s contracture most commonly affects which fingers?
- Ring finger
- Little finger
What are the risk factors for developing Dupuytren’s contracture?
- Male gender
- North European/Scandinavian descent
- Alcoholic cirrhosis
- Phenytoin therapy
- Diabetes
- Other fibromatosis
Besides Dupuytren’s contracture, name two other fibromatoses
- Peyronie’s disease (penis)
- Lederhose disease (plantar fibromatosis)
What does surgery for Dupuytren’s contracture involve?
- Removal of diseased tissue (fasciectomy)
- Division of cords (fasciotomy)
- Amputation (for the most severe cases)
How is trigger finger caused?
- Tendonitis of a flexor tendon can cause nodular enlargement
- This can cause the tendon to get trapped under the fascial pulley
- Usually the involved pulley is the A1 pulley
Why may a patient who has trigger finger experience their finger becoming trapped in a flexed position?
The nodule of the flexor tendon (as a result of tendonitis) becomes trapped under the fascial pulley
Which fingers are most commonly implicated in trigger finger?
Middle and ring fingers
How can symptoms be quickly relieved in trigger finger?
Injection of steroid around the tendon
If trigger finger is recurrent, what is the treatment?
Surgery to incise the affected pulley to allow free movemnt of the tendon
(division of just the A1 pulley does not affect function)
Postmenopausal women are associayed with high rates of OA in which joints in the hand?
DIP joints
How may mild-moderate OA in the hand be treated?
Removal of osteophytes and excision of associated mucous cysts
How may severe OA in the hand be treated?
Arthrodesis
In order to preserve pincer grip, which treatment is required for OA at the index finger?
Arthrodesis
(other fingers can have replacement arthroplasty)